Associations of Hospital-Level and Regional Factors With Receipt of Endoscopic Repair for Nonsyndromic Craniosynostosis

Background Endoscopic strip craniectomy represents an alternative to open cranial vault remodeling for repair of craniosynostosis. In addition to individual sociodemographic factors, hospital-level variables may affect the reception of such endoscopic procedures. This study incorporates a large national database to identify hospital-level and regional determinants of endoscopic repair for nonsyndromic craniosynostosis. Methods Open cranial vault remodeling and endoscopic strip craniectomy surgeries were identified in the 2016–2022 National Inpatient Sample. Admissions were characterized by hospital-level factors, such as hospital census division, bed size, ownership, and annual overall plastic surgery institutional volume. A multivariable logistic regression model was used to evaluate independent predictors of endoscopic repair ( P < 0.05). Results The final cohort comprised 12,785 nonsyndromic craniosynostosis repairs, 600 (4.7%) of which were endoscopic strip craniectomy procedures. Public hospital ownership was associated with lower odds of endoscopic repair compared to private nonprofit ownership (odds ratio [OR]: 0.30, 95% confidence interval [CI]: 0.21–0.43). Higher institutional plastic surgery volume also conferred higher odds (OR: 1.34, 95% CI: 1.25–1.43 per 100 cases). When compared to the Pacific region, all census divisions except the Mid-Atlantic (OR: 1.04, 95% CI: 0.72–1.51) and Mountain (OR: 0.84, 95% CI: 0.54–1.32) regions were associated with higher odds of endoscopic repair ( P < 0.05). Conclusions Multiple hospital-level factors, including hospital census division, ownership, and case volume, are associated with receipt of endoscopic strip craniectomy. This may reflect the impact of both state-specific insurance coverage and institutional experience on reception of endoscopic repair for nonsyndromic craniosynostosis.